My wife and I have been locked down on our little farm in rural Italy for a few weeks now. We’re only allowed off the property to go to the grocery store, the pharmacy or the post office. And when we go, we are required to bring along a signed form declaring our reason for leaving.
But we have it easy — living on a farm means we can let our dogs run around, and we have plenty of outdoor chores to keep us busy and active every day. We are thankful every day for our situation
Other people, unfortunately, don’t have the luxury of outdoor space. Many are squeezed into a smaller space than they’re used to… and often around the clock with people (even if they are loved ones) that there used to seeing only a few hours a day.
It’s no wonder than many people have asked me, “When can we expect to get back to something more normal? When can we go out again?”
The answer is… no one knows. But one of (or possibly multiple) of the following three things have to happen before policymakers can ease up on the Covid-19 (or C19) lockdowns.
NOTE: By “lockdowns” I mean the regulations put into place to limit interaction among people in an effort to slow the spread of the C19 virus. These may include drastic measures such as “sheltering in place.”
1. Widespread, Rapid Testing
If we could identify who is currently infected with the virus, we could isolate and observe them. In addition, if we knew who didn’t have the virus — or those who had the virus but were no longer contagious — we might be able to allow them to resume more normal activities.
There are two types of tests that might be used. The first is a test for the presence of the virus. These tests work by replicating bits of the virus until they reach a measurable level and therefore help to tell whether someone is infected with the virus when the test is taken. These viral tests are currently used to determine, for example, whether to hospitalized someone who is experiencing serious symptoms consistent with C19 infection.
The second type of test measures whether someone has mounted an immune response to the virus. Instead of detecting the virus directly, these tests check for antibodies to the virus. Based on the type of antibody detected, it’s possible to determine whether someone has been exposed to the virus.
Together, these two tests might help “bucket” people who don’t have any symptoms of C19. In theory, those of us who test negative for the virus could be allowed to return to normal activities — if we don’t harbor the virus, we can’t spread it. Even better, people who test negative for the virus but positive for antibodies may not pose a risk to others nor do they expose themselves to additional risk.
That’s the theory anyway. For this strategy to work, we would need to be able to test large numbers of people and get the results back quickly. The speed with which viral test results are available is important; the longer the delay between when the sample is taken for the test and the return of the results, the greater the chance that the person being tested could become infected with the virus.
In addition, having a large group of people who have not been exposed to the virus coming in contact with one another — the way we used to interact before lockdowns — is a breeding ground for the virus. Like a pile of dry tinder, we’d be set for a spark of the virus to quickly burn through us.
There are some caveats and obstacles to this approach. Scientists aren’t 100% certain that people who’ve successfully mounted an immune response to the virus won’t be reinfected. Although they believe it to be the case, it’s at least theoretically possible that people with antibodies can become infected again. And even if that reinfection doesn’t make them ill, they might pose a risk to those around them who’ve not yet been infected.
There’s also the challenge of staffing up enough people to field the tests and deal with those who are positive. This effort involves tracking down contacts of people who test positive, testing them, and isolating them if needed. This is precisely the type of legwork that public health officials are expected to do during outbreaks; pulling this off during a full-blown epidemic is several orders of magnitude more difficult.
Note that there may be ways to use technology to make contact tracing more manageable. We could, for example, agree to have our locations monitored via our phones or other devices. Public health workers could then use this information to more quickly identify contacts. These types of strategies come with limitations of their own (e.g., loss of privacy).
In short, we might be able to ease up on lockdowns if and when testing for both the virus and antibodies is widely available and provides quick results, and if a large enough workforce to field the tests and follow up contacts as needed can be trained and assembled. It’s not clear to me how quickly this could happen, but I’d guess at least something on the order of a few months at a minimum.
2. Identification of a Breakthrough Treatment
If we could successfully treat every or nearly all severe cases of C19, and do it without overwhelming the healthcare system, we wouldn’t need the lockdowns. In fact, if the infection didn’t bring along with it a significant chance of illness and death, the best strategy would be to allow everyone to become infected as quickly as possible.
Why would we do that? It turns out that once a minimum fraction of the population has become infected with the C19 virus, the virus will die out on its own. This effect is known as herd immunity — it means that the entire “herd” of people in an area becomes essentially immune to the virus once a certain fraction of people no longer can become infected.
Scientists aren’t exactly sure what that minimum fraction is for C19 herd immunity, but their current estimates are in the range of 60% or higher. That means the virus will sputter out if 6 out of 10 people in the population have gotten the infection and cleared it.
If we had a “silver bullet” treatment for C19, we could at least consider letting the virus run free. Within a few weeks, enough of us would be infected for the virus to die out on its own.
There are, of course, challenges with this approach. First, we aren’t anywhere close to having a highly effective treatment for the problems that come along with serious C19 infection. There are lots of ideas out there, but each of these needs to be tested so we know whether or not they really make a difference.
Second, even if we had a great course of therapy — which would be absolutely fantastic in terms of preventing loss of life — we’d need to be able to administer it easily and at scale. Remember that the primary goal of the lockdowns is to prevent the healthcare system from collapsing due to the weight of the epidemic. Even if we could prevent every additional death from C19, we still might put enormous stress on the healthcare system to deploy any new therapies, no matter how effective.
Finding a treatment that is both adequately effective and easily administered to allow policymakers to materially ease up on lockdowns seems to me to be a tall order. I’d guess that this would be something that’s six to eighteen months away… if ever.
3. Development of an Effective Vaccine
In some ways, this is the most familiar of the solutions. It’s how we’ve successfully handled a wide range of infectious diseases from the flu to the measles. Vaccines work by causing the body to produce antibodies even though there’s not an infection. This is a brilliant workaround, creating a short-cut from being healthy but vulnerable to infection to being healthy but no longer vulnerable… all without the need to becoming ill.
The challenge for developing a vaccine for the C19 virus is the timeline. To work, the vaccine needs to be available at scale; from a public policy perspective, the goal is to achieve herd immunity as quickly as possible. And that means vaccinating a large fraction of the population.
Vaccinating a large fraction of the population is obviously something that can’t be done until we’re certain that it’s safe. Consider the United States, for example. Let’s assume that we need 60% of the population to be successfully vaccinated (i.e., to achieve herd immunity). That’s about 200 million people. If the vaccine happened to cause significant problems in one in 10,000 people, we could expect about 20,000 people to run into problems from that vaccine.
To prevent that type of problem, regulatory agencies require a series of steps to demonstrate both safety and effectiveness, first in small numbers of people and then in larger groups. The upside is that this process helps avoid serious complications. The downside is that this takes time.
Vaccine development normally takes years and years, but because of the global pandemic, large sums of money and effort are being deployed to develop and test candidate vaccines for use against the C19 virus. Some experts are also suggesting that full-scale production be initiated for the most promising candidates even before the last stages of testing are completed. The thinking is that by running production and testing in parallel, months can be shaved off of the timeline.
In short, experts are estimating that a safe, effective and mass-produced vaccine will be available no sooner than about 12 to 18 months. And note that once a vaccine is produced at scale, it will need to be distributed across the country and deployed widely.
Oh, One Other Thing…
There’s still a possibility that the C19 virus will display the kind of seasonality we’re accustomed to with influenza viruses. If this is the case, we might get a bit of a breather in terms of high rates of new infections, hospitalizations and mortality. This would be a welcome break as additional progress could be made in any or all of the three strategies noted above.
There’s no way to know whether the C19 virus has a strong seasonal component, but we will get a sense of that soon. Regardless, seasonality isn’t a lock, and it’s certainly not sure enough for good policy to count on it happening.
Wrapping Up
All told, I think that it’s likely to be at least a few months before life returns to anything resembling normal. The most likely turn of events in the near term are 1) a substantial increase in the availability of testing for the virus itself, and 2) reliance on testing (both for the virus and for antibodies to the virus) to guide an interim policy to allow more people to get back to work. No one really knows, and there are significant challenges ahead, but this approach is probably a couple of months away.
This approach is also likely to be less like flipping a switch and more like slowly turning a knob. It will be implemented over time, and within specific geographic regions rather than all at once and everywhere. Patience will be required.
Until we have widespread and rapid testing, a breakthrough therapy, and/or an effective and widely available vaccine, we need to settle in for more of the same. Short of sacrificing tens or hundreds of thousands of lives to bring the economy back online, we’ve no other choice.